c antonal i ntervention p rogrammes h ealthy w eight (cip) and g ood, b etter or b est p ractice?...
TRANSCRIPT
CANTONAL INTERVENTION PROGRAMMES
HEALTHY WEIGHT (CIP) AND
GOOD, BETTER OR BEST PRACTICE?
Health Promotion Switzerland
Chiara Testera Borrelli
Head, Healthy Weight
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Best Practice
Context
Knowledge
Values
Best PracticeContext
Knowledge
Values
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General Context: 26 cantons
• Mountains: 70% of the area
• Highly federal system, 26 cantons
• Cantons are in charge of health
• Cantons large and small (Zürich: over 1,332’700 inhabitants; Uri: 57,750)
• Cantons rich and poor, urban and rural
• 4 languages / cultures
• Immigrant population: 20% average; great variation among cantons.
Illustration: Federal Office of Statistics
66%
20%
10%
Specific Context: origins of CIP initiative
▐ 2004: WHO Global Strategy on Diet, Physical Activity and Health
▐ 2005: our state-of-the-art report Healthy Weight: In 1999, 20% of Swiss children were overweight. In 2002, 37% of adults were overweight. Costs: CHF 2.6 billion
▐ 2005: meetings with almost all Cantonal Health Ministers ▐ 2004-2006: comprehensive quality assurance:
Best-Practice Framework for Health Promotion▐ 2006-2007: long-term strategy for Health Promotion
Switzerland, 2007-2018▐ 2006-2008: National Programme on Diet and Physical Activity,
2008-2012
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Specific Context: CIPs in strategic and knowledge environment
International level WHO Global Strategy on Diet, Physical Activity and Health
National levelNational Programme on Diet and Physical Activity 2008-2012
(Goal 4: Integrated approaches to promote healthy bodyweight)
Long term Strategy Health Promotion Switzerland
Cantonal levelCIPs
CIP: scope, objectives, target groups
▐ 4-year programmes▐ Long-term goal (2018): Increase proportion of population with
a healthy weight.Strategic goal, first stage (2007-2010): Slow down trend towards increasing overweight among children and adolescents by 2010.
▐ Target group(s): Children and adolescents (aged 0-16) and influential people around them (parents, teachers, medical practitioners, peers, …). Life-phase perspective (see following slides)
▐ Settings: pre-school, school, family, peer groups; any other relevant settings for target groups.
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Life-phase Perspective
Family
Young AdultsChildren III
Children II
Children IToddlersNewborn babies
Birth Adolescents
+ Peer Groups
e.g. food supply, advertising, spaces and programmes for physical activity, mobility
Environment
SettingsPre-school / School Working Life
or Higher Education
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Implementation Stages for CIPs
2) End 2008 (19 cantons)
3) July 201022 out of 26 cantons have signed contract, and are implementing their programmes
1) End 2007 (6 cantons in process of implementation)
Nationwide!Challenges to Practical ImplementationChallenge 1: desire for standardised programmesChallenge 2: respect each canton‘s individual situationGoal: standardised, flexible modules adaptable to each canton‘s needs
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Best Practice
Context
Knowledge
Values
Best Practice
Context
Knowledge
Values
Best Practice
Context
Knowledge
Values
Values and Principles
– in Swiss context• Strong basic democracy• Respect for cultural differences between members of Swiss German, Swiss
French and Swiss Italian linguistic communities
– in CIPs• All cantons have equal rights / equal duties• Shared responsibility for health: e.g. cantons must co-finance programmes• Transparency and Accountability: our resources are public money!• Respect of autonomy: each canton has different structures, needs and priorities.
Already existing projects must be integrated in the CIP• Sustainability of the programmes: efforts to anchor measures in existing
structures• Health equity: focus on vulnerable groups!• Focus on health and health determinants• Participation• Empowerment throughout
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Best Practice
Context
Knowledge
Values
Best Practice
Context
Knowledge
Values
Best Practice
Context
Knowledge
Values
Best Practice
Context
Knowledge
Values
The CIP Knowledge Base
▐ Scientific knowledge▐ Practice / Expert knowledge▐ Evaluation / Knowledge creation
CIP Scientific Knowledge▐ 2005: State of the Art Report Healthy Weight;
update due 2010▐ 2005: 5th Nutrition Report▐ Various new scientific resources / surveys (MOSEB)
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Practical / Expert Knowledge▐ 2010 State-of-the-Art Report: Scientific AND Practical Knowledge
(Best Practice). Results already being used to improve CIPs.▐ Annual CIP Networking Day for exchange and mutual learning (practice to
practice).▐ National CIP Advisory Board with cantonal representatives: source of expert
and practical knowledge.▐ Active participation in different national meetings or commissions:
important tool to activate scientific / practical / context knowledge. Example: Cantonal Steering Groups, where scientific knowledge is added.
Knowledge Creation: surveys, monitoring and evaluation
Healthy Weight Monitoring
Perspectives: Health Promotion Switzerland – Impact Management
Prevalence of overweight-related diseasesFOPH Project “KoLe“
Physical activity, nutrition, weight in SwitzerlandIndicators from Swiss Health Survey, Swiss Household Panel,..
Lamprecht & Stamm
BMI trends children and adolescentsBMI monitoring by School Medical Services; Lamprecht & Stamm
Policy monitoring Policy developments federal / cantonal levels – Dept.s of PHP
StakeholdersStakeholder surveys
Landert + Partners / t.b.a.
Physical activity, nutrition, weight in general populationPopulation survey - University of Lugano
Physical activity, nutrition, weight in print media Media monitoring BEG – Argus, University of Lugano
Physical activity, nutrition, weight at Swiss schools Situation monitoring at schools - University of Lugano
Investments, services, impactsOwn surveys, Health Promotion Switzerland
MediaMedia monitoring
Argus, University of Lugano
PopulationPopulation survey
University of Lugano
PolicyPolicy monitoring
Dept.s of PHP
Evaluation Cantonal Action ProgrammesWIG (Winterthur Institute for Health Economics),
Interface, University of Lugano
Evaluation Population CampaignUniversity of Lugano
Healthy Weight Evaluations
Evaluation action dInstitute for Addiction and Health Research (Inst. für Sucht- und Gesundheitsforschung)
Evaluation slowUpPolyquest, L&S
Self-evaluationHealth Promotion Switzerland
Meta Analysis – 2010t.b.a
How We Work (strategies)
Persuade cantons to become involved in CIP:
- Incentives (financial, others): Co-financing and sustaining CIP with tools and methodology- Advocacy: Overweight as a public-health priority- Building leadership: persuade Cantonal Executives to commit themselves to preventing
overweight
To reach our objectives within CIP:
- Integrated approach: promote healthy nutrition AND physical activity- Act on behavioural patterns AND living conditions- Life-phase perspective- Must-do: implement measures at all four levels1. Interventions for Children and Adolescents (Modules: transfer good practice;
avoid reinventing wheel; mutual learning) 2. Cantonal Policy Approach (improve living conditions) 3. Networking within and across cantons4. Increase public awareness at cantonal level (with national support)- Create / spread knowledge (ongoing and context-relevant)
For Example – the Swiss-Italian Canton of Ticino
Modules▐ Target groups: children aged 4 to 11, multipliers
(e.g. parents, teachers, physicians, care-givers), general population
▐ Projects, e.g.: At school: Movimento e gusto (Movement and Gusto / Taste).Train teachers in healthy nutrition and physical activity. Work with parents. Instill healthy culture in schools.
Outside School: Pédibus. Promote walking to school and provide safe
footpaths / access to school.
For Example – the Swiss-Italian Canton of Ticino
Policy Approaches- Fourchette Verte (Green Fork) for school children:
Ensure school caterers adhere to Swiss recommendations on nutrition (Label)
- Encourage promotion or sale of healthy food in schools (add healthy choices to vending machines for soft drinks and snack food)
Networking - Work with all other Latin cantons; collaborate with other organisations
or departments (of Education); major conference every three years
Raise public awareness- Intense effort to spread information (articles in consumer and other
magazines, radio and TV programmes, events)
Summary of Standardised CIP Self-evaluation
• Integration / expansion of existing projects and institutions / agencies• Decreasing development costs – transfer beginning to pay off• Most projects respond to structures and living conditions• Implemented actions becoming more visible• Focus still on Modules• Policy awareness improved but still too low• Greater awareness of issue of equal health opportunities• Improved networking among Latin cantons• Certain fatigue among Programme Leaders?• Context key to effective implementation• Target groups reached? can be measured only in 40% of all projects
Lessons Learned Regarding Best-Practice Approach▐ Main lessons learned in CIP implementation
Transfer works but context is key. Adaptation must be factored in.• Better use made of synergies.• Other key aspects: networking and mutual learning (saves resources)▐ Recommendations
Best-Practice Framework is:-- a valuable instrument for reflection on and further development of CIP:
e.g. concerning equal health opportunities, or sustainability of CIPs- Would be better used at beginning; developing programmes (e.g. CIP’s
Imitation Award)?▐ Knowledge sharing
Update State-of-the-art report – Practical Knowledge. Presentations in cantons and national conferences.
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Thank you for your attention
For any further information, please contact:[email protected]
Health Promotion SwitzerlandDufourstrasse 30, P.O.Box 311, 3000 Bern 6, SwitzerlandTel. +41 (31) 350 04 04 - Fax +41 (31) 368 17 00www.healthpromotion.ch